Complete the questionnaire below to see if you’re a good fit: This information is confidential and will be used solely for our screening purposes.

1. General Fitness:

Where are you based?

Gender:

—Please choose an option—MaleFemale

What are your current fitness levels and experience?

A. BeginnerB. IntermediateC. Advanced

Physical Activity Level at Work:

—Please choose an option—1. Very Light: Example, sitting at the computer most of the day, or sitting at a desk2. Light: Example, light industrial work, sales or office work that comprises light activities3. Moderate: Example, cleaning, staffing at kitchen, or delivering mail on foot or by bicycle.4. Heavy: Example, heavy industrial work, construction work or farming.

Physical Activity at Leisure Time:

—Please choose an option—1. Very Light: Almost no activity at all.2. Light: Example, walking, non-strenuous cycling or gardening approximately once a week.3. Moderate: Regular activity at least once a week, e.g., walking, bicycling, or gardening or walking to work 10–30 min day.4. Active: Regular activities more than once a week, e.g., intense walking or bicycling or sports5. Very Active: Strenuous activities several times a week.

Have you completed the Shrinkbelly’s exclusive Fitness & Wellness Mastery Bootcamp Program before? to access exclusive tools and guidance:

—Please choose an option—1. Yes, I did, but I need more guidance and support2. Not yet, but I plan to in the next 30 days3. I wasn't aware of the program—please send me more information to get started

Interested in joining our WAITING LIST for guidance, support, or private coaching? Please note: This option is only available if you’ve completed or enrolled in the Shrinkbelly Bootcamp program

—Please choose an option—1. Yes, please2. Not yet, still deciding

If yes, please provide your preferred Telegram or WhatsApp number

Why do you really want to lose weight?

A. Improve overall healthB. Increase energy levelsC. Boost self-confidenceD. Prepare for an upcoming eventE. Follow medical adviceF. Enhance physical appearance

What are your specific weight loss goals?

A. Lose 5-10 pounds/ 2-5kgB. Lose 11-20 pounds/5-9kgC. Lose more than 20 pounds/9kgD. Maintain current weight while gaining muscle

Do you have any medical conditions or injuries?

A. Yes, I have medical conditionsB. Yes, I have injuriesC. No

How much time can you realistically dedicate to exercise each week?

A. Less than 2 hoursB. 2-4 hoursC. 4-6 hoursD. More than 6 hours

What types of physical activities do you enjoy?

A. Cardio (running, cycling, swimming, Walking)B. Flexibility (yoga, Pilates)C. Outdoor activities (hiking, kayaking)D. Strength training (weightlifting, bodyweight exercises)E. Team sports (basketball, soccer)

Do you have access to a gym or specific fitness equipment?

A. Yes, I have a gym membershipB. Yes, I have home fitness equipmentC. No, I need equipment-free workoutsD. No, I prefer bodyweight exercises

How will you track your progress?

A. JournalingB. Fitness appsC. Regular weigh-insD. Measurements (waist, hips, etc.)

2. Nutrition and Dietary:

What is your current dietary intake like?

A. Mostly balanced with occasional treatsB. High in processed foods and snacksC. Vegetarian or veganD. Low-carb or keto

How many meals and snacks do you eat per day?

A. 2-3 meals, no snacksB. 3 meals, 1-2 snacksC. 3 meals, 3+ snacksD. I graze throughout the day

What are your macronutrient needs (protein, fats, carbohydrates)?

A. High protein, moderate carbs, low fatB. High protein, low carbs, moderate fatC. Balanced protein, carbs, and fatD. Unsure, need guidance

Do you have any dietary restrictions or preferences?

A. Yes, allergies (gluten, nuts, etc.)B. Yes, intolerances (lactose, etc.)C. Yes, ethical choices (vegetarian, vegan)D. No

How much sugar do you currently consume daily?

A. Minimal, I avoid added sugarsB. Moderate, occasional sweetsC. High, daily sweets and sugary drinksD. Unsure

Are you getting enough fiber in your diet?

A. Yes, plenty of fruits, vegetables, and whole grainsB. Some, but could improveC. No, low fiber intakeD. Unsure

How much water do you drink daily?

A. 8+ glassesB. 5-7 glassesC. 3-4 glassesD. Less than 3 glasses

3. Sugar-Specific

What are the main sources of sugar in your diet?

A. Sweets and dessertsB. Sugary drinks (soda, juices)C. Processed foods (cereals, sauces)D. Fruit

Do you consume sugary drinks (soda, juices, energy drinks)?

A. Yes, dailyB. Yes, occasionallyC. RarelyD. No, I avoid them

Are you aware of hidden sugars in processed foods?

A. Yes, I check labels regularlyB. Somewhat, I try to be mindfulC. No, I need to learn moreD. I don’t check labels

How often do you eat desserts or sweets?

A. DailyB. A few times a weekC. Once a weekD. Rarely

Do you find yourself craving sweets or sugary snacks regularly?

A. Yes, every dayB. A few times a weekC. OccasionallyD. Rarely

Can you identify low-sugar alternatives for your favorite foods?

A. Yes, I use them oftenB. Yes, but I don’t use them regularlyC. No, but I am interestedD. No, I prefer regular options

How often do you experience fatigue or low energy levels, especially after meals?

A. Frequently, after every mealB. Sometimes, after large mealsC. RarelyD. Never

Have you been diagnosed with insulin resistance or prediabetes?

A. YesB. NoC. Unsure

4. Behavioral and Lifestyle:

What triggers your cravings for unhealthy foods?

A. StressB. BoredomC. Social situationsD. Lack of sleep

Have you tried intermittent fasting before?

A. Yes, I currently practice itB. Yes, I have tried it in the pastC. No, but I am interestedD. No, not interested

What type of fasting have you tried or are interested in trying?

A. 16/8 (fast for 16 hours, eat during an 8-hour window)B. 5:2 (eat normally for 5 days, restrict calories for 2 days)C. Alternate-day fastingD. Extended fasting (24 hours or more)

How do you manage stress and emotional eating?

A. ExerciseB. Meditation or yogaC. Talking to friends/familyD. I struggle with this

Do you have a support system for your weight loss journey?

A. Yes, friends and familyB. Yes, online communities or support groupsC. No, but I am looking for oneD. No

Have you noticed any unexplained weight gain, particularly around the abdomen?

A. Yes, significant gainB. Yes, moderate gainC. No, slight gainD. No

Do you have trouble concentrating or experience “brain fog” during the day?

A. Yes, frequentlyB. SometimesC. RarelyD. Never

How often do you experience trouble sleeping or insomnia?

A. Frequently, almost every nightB. Sometimes, a few times a weekC. RarelyD. Never

Have you noticed inflammation, any skin issues, such as acne or dry skin, particularly after consuming sugary foods?

A. Yes, oftenB. OccasionallyC. RarelyD. Never

Do you experience some of these mental health symptoms: Dissociation, Increasing anxiety, Too much irritation or Depression?

A. Yes, frequentlyB. SometimesC. RarelyD. Never

How do you handle setbacks or plateaus in your progress?

A. Adjust my plan and keep goingB. Seek advice from othersC. Take a break and restart laterD. I struggle to stay motivated

Are you getting enough sleep?

A. Yes, 7-9 hours per nightB. Sometimes, 5-6 hours per nightC. Rarely, less than 5 hours per nightD. I need help improving my sleep

When do you want to start your Weight loss Journey with Shrinkbelly?

A. Anytime!B. Sometime next monthC. In 3 Months timeD. Not sure yet

Do you prefer investing in wellness and fitness education to take a DIY approach with minimal guidance, or would you rather rely on private coaching?

—Please choose an option—1. Invest in Wellness & Fitness Learning for DIY2. Rely on Private Coaching3. I prefer both

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